三维经食管超声心动图评估人工机械瓣血管翳梗阻的临床价值  

Clinical value of three-dimensional transesophageal echocardiography in evaluating obstruction of pannus on artificial mechanical valve

作　　者：余璞 左浩 段茂 管雪 殷亚飞 许敏 黎清龙 徐亚丽 YU Pu;ZUO Hao;DUAN Mao;GUAN Xue;YIN Yafei;XU Min;LI Qinglong;XU Yali(Department of Ultrasound,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院超声科,重庆市400037

出　　处：《临床超声医学杂志》2024年第2期137-141,共5页Journal of Clinical Ultrasound in Medicine

基　　金：陆军军医大学优秀人才项目(2019R038)。

摘　　要：目的探讨三维经食管超声心动图(3D-TEE)在评估人工机械瓣血管翳梗阻的临床价值。方法选取我院经手术证实的人工机械瓣血管翳患者46例,其中人工二尖瓣血管翳22例,人工主动脉瓣血管翳24例,应用3DTEE观察人工机械瓣血管翳成像特征,并测量血管翳面积、血管翳内面积与血管翳外面积比值、血管翳宽度与瓣膜外径比值(W/D),经胸超声心动图测量平均跨瓣压差(mTPG),分析3D-TEE参数与mTPG的相关性。根据人工机械瓣梗阻程度分级将患者分为显著梗阻者与可疑梗阻者,比较二者3D-TEE所测血管翳环绕角度≥180°占比。结果人工主动脉瓣血管翳内面积与血管翳外面积比值、W/D、血管翳面积均与mTPG具有良好的相关性(r=-0.782、0.820、0.741,均P<0.001);人工二尖瓣血管翳内面积与血管翳外面积比值、W/D、血管翳面积均与mTPG具有良好的相关性(r=-0.793、0.878、0.806,均P<0.001)。人工主动脉瓣显著梗阻者血管翳环绕角度≥180°占比为94.74%,显著高于可疑梗阻者(20.00%),差异有统计学意义(P=0.002);人工二尖瓣显著梗阻者血管翳环绕角度≥180°占比为100%,显著高于可疑梗阻者(14.29%),差异有统计学意义(P<0.001)。结论3D-TEE在评估人工机械瓣血管翳梗阻程度方面具有重要价值,其中3D-TEE定量参数包括血管翳面积、血管翳内面积与血管翳外面积比值及W/D均能准确判断人工机械瓣血管翳有无梗阻及其程度,尤以W/D更佳。Objective To investigate the clinical value of three-dimensional transesophageal echocardiography(3D-TEE)in evaluating obstruction of pannus on artificial mechanical valve.Methods A total of 46 patients with surgically confirmed pannus on the artificial mechanical valve in our hospital were selected,including 12 cases of pannus on the artificial mitral valve and 22 cases of pannus on the artificial aortic valve.3D-TEE imaging characteristics of pannus were observed,and the pannus area,the ratio of the intra-pannus area to the extra-pannus area,and the ratio of pannus width to valve external diameter(W/D)were measured.Mean transvalvular pressure gradient(mTPG)was measured by transthoracic echocardiography(TTE),and the correlation between 3D-TEE parameters and mTPG was analyzed.The artificial valves were categorized into significant stenosis and possible stenosis according to the degree of stenosis,and pannus surrounding angle≥180°measured by 3D-TEE was compared between the two items.Results The ratio of the intra-pannus area to the extra-pannus area,W/D,pannus area of artificial aortic valves were all correlated with mTPG(r=-0.782,0.820,0.741,all P<0.001).The ratio of intra-pannus area to the extra-pannus area,W/D,pannus area of artificial mitral valves were all correlated with mTPG(r=-0.793,0.878,0.806,all P<0.001).The proportion of pannus surrounding angle≥180°in patients with significant stenosis of artificial aortic valve was 94.74%,which was higher than that in patients with possible stenosis(20.00%),and the difference was statistically significant(P=0.002).The proportion of pannus surrounding angle≥180°in patients with significant stenosis of artificial mitral valves was 100%,which was higher than that in patients with possible stenosis(14.29%),and the difference was statistically significant(P<0.001).Conclusion 3D-TEE has significant value in assessing the degree of artificial valve pannusobstruction. The quantitative parameters of 3D-TEE,including pannus area,the ratio of the intra-pannus area to

关 键 词：超声心动描记术 经食管 三维 人工瓣血管翳 瓣膜梗阻 

分 类 号：R540.45[医药卫生—心血管疾病] R318.11[医药卫生—内科学]